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NPI Code Detail

MEDICARE: ELDA LAURAS OPTICAL LATINA LLC

MEDICARE: ELDA LAURAS OPTICAL LATINA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist8227-TTX

General Provider Information

NPI Number : 1548681364
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELDA LAURAS OPTICAL LATINA LLC
Provider Business Mailing Address
First Line : 8410 FONDREN RD
Second Line :
City : HOUSTON
State : TX
Zip : 77074-5616
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8410 FONDREN RD
Second Line :
City : HOUSTON
State : TX
Zip : 77074-5616
Country : US
Telephone Number : 713-271-6567
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST/OWNER
Name : MISS DIANA L TREJO
Credential : OD
Telephone Number : 713-271-6567
Provider Enumeration Date : 12/20/2013
Last Update Date : 01/24/2014

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Directions to “ELDA LAURAS OPTICAL LATINA LLC ” Practice Location

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